SYB 3 General Radiology An Dang Do March 5, 2008

79 yo WM POD #8, cystectomy; acute onset of severe abdominal pain; (recently received chemotherapy treatments for urothelial cancer)

CT Image

Necrotizing Enterocolitis -one of the more concerning causes of portal venous gas -most common in immunosuppressed patients -necrosis of various layers of bowel walls, almost always cecum (typhlitis) Contributing factors: mucosal injury profound neutropenia impaired host defense Microbes involved: Gram(-) rods; Gram (+) cocci; anaerobes; Candida sp. Signs and symptoms: ANC < 500/microL fever, abdominal pain/distension, N/V, watery/bloody diarrhea Song L-M WK, Marcon NE. Necrotizing enterocolitis (typhlitis) in adults. UpToDate. Version Accessed March 4, 2008.

Necrotizing Enterocolitis - Management

Iatrogenic Complication CXR taken after placement of left subclavian line

Lines and Tubes

Portal venous gas Free air in abdomen Distended stomach CT Image Although findings of portal venous gas, thickened proximal jejunal wall, pneumatosis and pneumoperitoneal were seen on CT and prompted concerns for necrotizing enterocolitis, two exploratory laparotomy procedures did not show any ischemic bowels or perforation.

Iatrogenic Complication Left pneumothorax

Lines and Tubes Mediport NG tube ET tube Keofeed tube Chest tube Swan-Ganz catheter